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Who should pay for infertility treatments?

We were in Montreal for a few hours on Sunday to celebrate an anniversary, and while we were there we were treated to a tour of the Ovo fertility clinic. (Someone in GC’s family works there.)

You should see this place. It was designed by architects who really took off with the theme of fertility and wombs and so on. I only took a few pictures – I wish I’d taken more, but for some reason I felt like I was intruding on something private.

There are three floors to the clinic. The ground floor is for women who are trying to get pregnant. On the wall is a mosaic of photographs of babies who were conceived at the clinic. The second floor is for women who have succeeded in becoming pregnant and whose fetuses are being shepherded through the treacherous nine months to safe delivery. The third floor is the administration offices.

Photo: The Bioarchive

The clinic has seventy employees and tons of state-of-the-art equipment, including 3D and 4D ultrasound machines, genetic testing equipment, and a bioarchive for storing umbilical cord blood (stem cells). The bioarchive, instead of being hidden away in a lab, is featured prominently in the design of the facility. (They won a 2009 Best of Canada Institutional Design Award for this.)

There are also cryogenic freezers, an embryology lab, a genetics lab, a stem cell lab and a biochemistry lab. We didn’t get to see all of the labs because they have a million-dollar air quality system, and they’re very particular about who can go in there.

Photo: Womb Room

I liked this ultrasound room, which was designed to simulate a womb. But the most interesting rooms were the Salles d’Homme. The Men’s Rooms. There’s a big masculine brown leather chair in the centre of each cozy, well-appointed room. A TV. Discreetly tucked into an elegant dark wood cabinet are a selection of men’s magazines and DVDs. On the wall is a small tasteful dark wooden door to a built-in compartment with a lock. Inside the compartment is a silver cup. The silver cup is the receptacle for the sperm sample. Once the man has completed his mission, he places the silver cup and its precious contents in the compartment and locks it. A nurse then retrieves it from the other side of the wall. It’s all very dignified. (Practically reverent, even.)

I always took my fertility for granted – in fact, there were times I cursed it. All those periods, all that birth control. But while fertility might be a nuisance, infertility would be a far greater burden. Some people go to great lengths – medically, emotionally and financially – to have a baby.

Currently Quebec offers tax credits of 50% of the cost of fertility treatments. It’s the only province to do so. Quebec is even considering paying the full freight for up to three rounds of in vitro treatments ($30,000) per family. They expect the number of couples seeking treatment will increase from 2,500 to 10,000 per year if it’s publicly funded. The Ovo Clinic – one of four fertility clinics in Montreal – currently has a waiting list of 300 couples. More clinics would need to be constructed if Quebec does decide to go that route.

10,000 couples times $30,000 = 300 million dollars. That’s a lot of money. (You could host one day of a G20 meeting for that kind of money.)

What do you think? Should the cost of infertility treatments be at least partially covered by the public health care system?

22 comments to Who should pay for infertility treatments?

It’s so heartbreaking for so many couples… I think it should be covered. Having it covered by the public health care system allows regulation to avoid all those stupid stories of excess we hear about now and then (octomom, the 60 year old new mom). I think the Quebec rule about only letting it go so far would ensure it doesn’t become an obsession that costs the system too much. Right now Canadians who want to give it a try but can’t afford multiple attempts are tempted by trying more embryos at once. Health care funding would help avoid that.

Citizens in states like Canada put a heavy burden on the planet as a consequence of their wealth. As such, I think it makes sense to encourage them to be more reproductively abstinent. By that, I don’t mean forbidding people to have children. Rather, I mean removing public financial support where possible, leaving parents to bear more of the costs associated with their choice.

I’m going to apply the same test to this question as I do everything else healthcare related. Is it, according to a reasonable person, considered medically necessary? If the answer’s no, then the procedure shouldn’t be publicly funded. It may be a tiny bit cold-hearted, but your post kind of points out why I say that. Just in Quebec, the price tag could be as high as $300 million if as many as they’re guessing actually take up the offer. That’s just in Quebec. Neverminding the fact it wouldn’t *actually* be the Quebec tax payer paying for it, I’d be willing to bet there’s not a province up here that’s not running a negative balance right now. To include under the list of services publicly funded something that, in my opinion, is entirely elective would be nothing short of ridiculous. And, because I know at least one person’s probably going to raise the point that these people likely don’t have much other choice, I’m going to put it rather simplisticly. There’s several thousand kids without parents just in Canada. Surely parents who can’t have children on their own who don’t want to pay for the treatments etc can at least investigate the possibility of adoption. Or, failing that, just accept the fact they just can’t have kids. It sucks, but I doubt it’ll kill you.

I agree that subsidizing adoption makes a lot more sense than subsidizing fertility treatments. After all, children awaiting adoption already exist. It is probably to everybody’s benefit that they be raised by caring parents.

Absolutely not. Having children made from your own precious, oh-so-special DNA is a egotistical craving, not a necessity to the continuation of the species. Adoption both within and from outside the country is a much better way to deal with infertile women (who are often infertile for sound survival-of-the-fittest reasons.) However, who’s going to ever convince all those broody mares that just because it’s *theirs*, it’s not *better*?

I’m with Milan. If an otherwise infertile woman is all frothing at the mouth to bear her own baby, she/they should be responsible for 100% of the costs incurred.

As someone who was on the verge of paying for treatments when my wife got pregnant, I would have liked to have some government assistance. Especially considering things like sex changes are covered. If having your gender changed is a human right, they I think you could easily say that having a child is too.

But to answer the question, no I don’t think it should be covered.

Now as a rule I tend not to insult people in blog comments. But I’m going to make an exception today.

Susan, you are a complete idiot. To assume that people with fertility problems are less fit for survival than other ignores the complete randomness of evolution. There is no sound reasoning in evolution. It also ignores all the people who are huge drains on society as they do nothing but reproduce and collect welfare cheques. Are you telling me that their genes are more fit for survival. You are also ignoring that people can become infertile because of infections and other health reasons. Or does that fit under your definition of sound reasoning too.

Perhaps I’m cynical, but I believe that the government of Quebec is motivated to do this because they want to increase the population of Quebec, and not because they want to help couples per se. Quebec has a history of encouraging their residents to have more children, with baby bonus payments and generous daycare subsidies. That being said, I feel so unbelievably lucky to have had my two children, and I believe that there should be assistance for couples who do want to have a baby of their own.

I don’t know if I think it should be fully funded and I shudder at the bump watch society that we live in given that population growth is a real problem, but infertility is a health issue and having biological children can be a pressing biological need.
I am not saying that adoption, or adopted children are any less special, just that I wouldn’t say it is simply selfish to want to reproduce. I don’t quite understand why people seem so quick to simply say “no”.

I think “No”. The money shoud go to help sick people. Being an infertile is not sickness. You can live with it. Be a cancer patient and not to receive a treatment (and some cancer drugs cost a fortune), means you would die. Simply.

If the money isn’t shifted from funding that would otherwise cover abortions and birth control and prenatal care, then I see no problem with it. Of course, I live in a country where Viagra is covered, but BCPs and such often are not, so my opinions are no doubt affected by that.

First of all, I don’t want our health care system to degenerate into only covering life or death treatments, drugs and procedures.

But, I look at hospitals I’ve been in in Quebec and how understaffed they seem to be wrt nursing staff and how run down the buildings are…and how chic this clinic is and I really wonder about the high cost of fertility treatments and things which are services that I do believe should be fully funded (like umbilical stem cell collection and storage). This clinic is funded privately. What percentage of those client’s fees are going to architecture an?d silver cups?

I’ve been through all sorts of tests to understand gynecological and fertility issues I have, which was covered by OHIP in Ontario. The hospital (women’s college) was bright, clean, and bare bones. It is a teaching hospital too. The gynecologist’s offices were all modestly decorated too.

I guess I’m sort of offended by this clinic!

I’m also suspicious about why Quebec is so keen to fund this. My experience living in Quebec (and make no mistake that would NEVER make me a Quebecker!) is that the government fears immigrants (from other countries and from other provinces) because they do not vote along any kind of separatist/distinct society/French lines. After generations of church control and government support of that control (birth control illegal) Quebeckers are having much smaller families, having families much later, or choosing not to have families at all.

First to MG – Sex change can absolutely not be compared to fertility treatments. There is no reason why bearing a child should be a human right, while correcting what is basically a birth defect should be. If you want to be a parent and are unable to bear a child there are, as others have pointed out, plenty of children in this country who desperately need parents. It seems selfish and irresponsible to me to expect the government to pay to engineer a biological child for you, while there are so many ways that money could help children that already exist. I also agree with Mudmama that this clinic is rather offensive.

Thanks for all the comments. I agree with those of you who say no. If we had unlimited money, my answer would be different, but given that our health care system is already facing some formidable challenges in the sustainability department, and these challenges are only going to get worse as the population ages, I don’t think it’s the best use of our money.

As for the clinic itself, yes, it’s more than a little opulent for the public health care system. While I don’t have a problem with the expensive equipment, I don’t think it needs to be competing for architectural and design awards.

XUP – Can infertility not be considered a birth defect in some cases? Why one defect over another?

mudmama – I assume your welfare comment was directed at me. I never meant to imply that everyone on welfare is was a huge drain on society. But there are some that are.

And as for adoption. My understanding is that the wait times for a new born baby are extremely long and raising a child that was adopted at an older age can be a extremely difficult task and I can completely understand some people might not wanting to undertake it.